Ecommerce Service Request

eCommerce Service Request

Revised 06/01/2018

ecommerce service request

Table of Contents

1.Applicable policies and procedures

2.Routing Instructions

3.Request Form

Customer Information

Description of eCommerce Service Request

Account Information

Merchant ID/Verisign Account Information

Authorizations

1.Applicable policies and procedures

TTUHSC El Paso Operating Policy 50.37, Payment Card Processing by TTUHSC El Paso Departments

TTUHSC El Paso Operating Policy 56.01, Use of Information Technology

2.Routing Instructions

Please route this request in the following order for proper processing. Addresses are provided below.

Requesting Department

Requesting Department

NOTE: TTUHSC El PasoInstitutional Compliance must also approve eCommerce requests related to any activity that involves patients or patient information.

3.Request Form

Customer Information

Date: 10/8/2018
Requestor:
E-Mail address:
Requesting Department’s Business Name:
Department Code:
Physical Address:
Campus:
Phone Number:
Fax Number:
Mail Stop:
Department Primary Contact:
Title:
E-mail address:
Project Contact: KarinaEscapita
E-mail address:
Technical contacts and e-mail addresses:
Alejandra Delgado –
Mario Sosa -

Description of eCommerce Service Request

Describe your need for the ecommerce service:
List of Products/Services:
Mark the credit cards your department wishes to accept:
_ _ Visa/MasterCard _ _ Discover _ _ American Express
Note: Please be aware that each credit card has separate fees. For more information, contact Accounting Services.
Projected Annual Sales: / $
Web Address, if available (Home Page):

Account Information

Account Name:
Account Number (FOAP:Fund – Organization – Account - Program):
Revenue Account:
Do you want the associated credit card and other related fees charged to the account above?
_ _ Yes _ _ No
If no, please indicate the account to be charged for the associated credit card and other fees related to this eCommerce request below:
Account Name:
Account Number (FOAP - Fund Orgn Acct Prog):

Merchant ID/Verisign Account Information

A separate Merchant ID account is required for each eCommerce site Banner Revenue Account unless otherwise approved.
It is the responsibility of the requesting department to purchase a Merchant ID account (if you do not already have one) for eCommerce processing.
The requesting department is also responsible for paying the initial setup fee for the Merchant ID account and all fees associated with processing the transactions. These fees are 2-4% of the total transaction amount, depending on the credit card used (Visa, MasterCard, Discover, and American Express all have different fee rates).
Accounting Services Contact Information:
Roxanne Lerma, Analyst II

915-215-4863 / Sandra Tapia, Unit Associate Director

915-215-4790
Merchant ID/ Verisign Account:

Authorizations

Requesting Department Approval:
______
Department HeadDate
TTUHSC El PasoIT Division Academic TechnologyApproval:
______
Authorized Signature Date
TTUHSC El PasoInformation Security Officer Approval:
______
Authorized Signature Date
TTUHSC El PasoAccounting Services Approval
______
Authorized Signature Date
TTUHSC El Paso Technology Services Approval
______
Authorized Signature Date
TTUHSC El Paso Institutional Compliance Approval (if applicable)
______
Authorized SignatureDate

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